Claims Examiner analyzing workers' compensation claims for clients, ensuring benefits are adjudicated within service expectations and industry best practices. Requires significant claims management experience and knowledge of California regulations.
About the role
- Claims Associate responsible for managing workers compensation claims within company standards. Providing client support and documenting claims accurately while ensuring efficient processing in the Plano office.
Responsibilities
- Analyzes reported lower-level workers compensation claims to determine benefits due.
- Ensures ongoing adjudication of claims within company standards and industry best practices.
- Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision.
- Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
- Processes workers compensation claims determining compensability and benefits due.
- Monitors reserve accuracy and files necessary documentation with state agency.
- Communicates claim action/processing with claimant, client and appropriate medical contact.
- Ensures claim files are properly documented and claims coding is correct.
- May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.
- Maintains professional client relationships.
Requirements
- High school diploma or GED required.
- Licenses as required.
- One (1) year of general office experience or equivalent combination of education and experience required.
- Claims industry experience preferred.
- Jurisdiction Knowledge: CO, UT, WA, OR and TN Licensing: TX/FL preferred.
Benefits
- Flexible work schedule.
- Referral incentive program.
- Opportunity to work in an agile environment.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
SE
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